Unlocking the colon clock: Bridging the gap in colonic transit time studies for optimal management of chronic constipation

Table 1 Segmental and total colonic transit time using radiopaque markers across populations and protocols

Ref.	Sample size/population	Marker ingestion protocol	X-ray timing/type	Key findings	Results (mean CTT or segment analysis)
Arhan et al[41], 1981	23 children, 38 adults	20 markers at 0 hour	Daily until marker clearance	Children show rectosigmoid stagnation	Children: Right 7.7 hours; left 8.7 hours; rectum 12.4 hours; adults: Right 13.8 hours; left 14.1 hours; rectum 11 hours
Metcalf et al[12], 1987	73 controls (group I: 24; group II: 49)	20 markers at 0 hour, 24 hours, 48 hours	Group I: 24 hours, 48 hours, 72 hours; group II: 72 hours	Validated single-film technique	Segmental: Right 11.3 ± 1.1 hours; left 11.4 ± 1.4 hours; rectosigmoid 12.4 ± 1.1 hours
Nabar et al[42], 1995	25 NUD patients, 25 controls	20 markers at 0 hour, 9 hours, 18 hours	27 hours	Altered motility in patients with NUD who were asymptomatic	NUD: 9.0 hours; controls: 15.8 hours
Pai et al[51], 1999	20 healthy males	Markers at 0 hour, 12 hours, 24 hours	12 hours and 36 hours	Two X-rays improved the accuracy in the rapid transit populations	Mean CTT: 24.2 ± 6.8 hours
Ghoshal et al[14], 2007	31 total (9 HD; 11 CIPO; 11 controls)	Markers at 0 hour, 12 hours, 24 hours	36 hours and 60 hours (erect)	60 hours of X-ray is better for HD/CIPO diagnosis	HD/CIPO showed increased retention (HD: Distal; CIPO: Proximal)
Pomerri et al[23], 2007	159 patients with FC (group I: 52; group II: 107)	Group I: 10 markers/day for 10 days; group II: + barium paste on day 9	Day 11 (supine)	Barium paste showed no clinical impact	Group I: 85.75 ± 46.08 hours; group II: 74.94 ± 49.34 hours (NSD)
Abrahamsson et al[52], 2010	15 controls, 13 patients with FC	50 particles/day for 6 days	Day 7	Validated marker quantity requirements	Proposed 10-12 markers/day for accuracy
Cho et al[26], 2013	47 healthy adults (24 F; 23 M)	20 markers/day for 3 days	Day 4 (supine)	Significant sex differences in CTT	Males: 8.8 hours; females: 24.7 hours
Bhate et al[43], 2015	50 patients with FC, 25 controls	4 gelatin capsules (5 markers each) at 0 hour, 12 hours, 24 hours	36 hours (single X-ray)	Right colon transit is slower in FC vs controls	FC: 23.0 hours; controls: 15.4 hours

CTT: Colonic transit time; NUD: Non-ulcer dyspepsia; HD: Hirschsprung’s disease; CIPO: Chronic intestinal pseudo-obstruction; NSD: No significant difference; F: Female; FC: Functional constipation; M: Male.